Are E-Cigarettes Ever a Good Idea?

Source

Article titled "Evidence, Policy, and E-Cigarettes—Will England Reframe the Debate?" by Sharon H. Green, MPH, project coordinator, Mailman School of Public Health, Columbia University, New York City, and colleagues, published in The New England Journal of Medicine.

Date

May 23, 2016

Publication

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If you smoke and want to start an argument, here’s how—just tell your friends that you’re switching to e-cigarettes.

Some might applaud you for taking a positive step—and even suggest the best brands to try. Others will warn you that you’re jumping from the frying pan into the fire, falling prey to a new and largely unknown harm—and a new addiction.

To understand what this means for our readers, we spoke with Sharon H. Green, MPH, a researcher at Columbia University’s Mailman School of Public Health, who recently covered e-cigarette controversies in The New England Journal of Medicine. Are e-cigs merely a new way for Big Tobacco to keep people hooked…or could they play a role in helping some people quit? Do they benefit health even if you don’t quit?

In short, do e-cigarettes ever make sense?

Green believes that for some people, they do.

NEW FDA REGULATIONS…AND NEW CONTROVERSY

Until now, electronic cigarettes have been entirely unregulated—a true Wild West. They can include any of hundreds, even thousands, of ingredients—including flavorings such as “gummy bear” that appeal to kids. Some of these flavorings and other ingredients have been shown to pose health risks—butter flavor, for example, has been linked to a lung disease called popcorn lung.

The new FDA regulation means that e-cigarettes—along with cigars, pipe tobacco and hookahs—will be banned for sale to minors by this summer. Over the next two years, manufacturers with products that are on the market now are required to divulge all ingredients and submit any health claim to the FDA for approval. These are positive steps, says Green. Among public health advocates, she says, “Everyone agrees about banning sales to minors—and registering ingredients. Quality control is a good thing.”

But the Truth Initiative (formerly the American Legacy Foundation), the nation’s largest nonprofit anti-tobacco group, argues that e-cigarettes are less harmful than tobacco cigarettes and may help some people quit smoking. To add to the confusion, Public Health England, the British counterpart to our CDC, and the Royal College of Physicians, a British professional medical body, strongly support encouraging smokers to turn to e-cigarettes—even if they aren’t able to quit smoking entirely.

BALANCING RISKS

Green readily agrees that e-cigarettes may pose small adverse health effects, that we don’t know exactly what the risks are and that, “it will be years before we do know—especially for long-term use.” That’s why she’s sure of one thing. “I would not advise anyone who is not a current smoker to take up e-cigarettes.”

On the other hand, she argues, while e-cigarettes have possible risks, which according to the current state of the evidence is a tiny fraction of the risk of combustible cigarettes, tobacco products have proven risks. “Tobacco products kill 480,000 Americans a year,” she says. And while research hasn’t proven e-cigarettes help people quit smoking, there is evidence that they do help some people—and she weighs that against the frustration most smokers have in quitting. “Seventy percent of smokers say that they want to quit—but only 6% of those who want to quit do quit that same year,” she says. “Not only is it extremely difficult to quit this addiction, but the smoking-cessation tools that we have haven’t proven to be effective enough.

“We need a new approach,” she says. “So anything that smokers find useful and is less damaging to their health—including e-cigarettes—we should embrace.” Inhaled nicotine, as in e-cigs, reaches the brain faster than the nicotine in patches and gums, she notes, which can help people fighting nicotine cravings. Some brands of e-cigarettes allow smokers to taper down the level of nicotine, which some smokers may find helpful in reducing dependency.

If you are trying to quit, or know someone who is, by all means work with a doctor so that you can try a combination of approved prescription aids such as nicotine patches, gums, and prescription inhalers—along with quit-smoking counseling available in free call lines, texting apps and more.

But if these approaches don’t work, “e-cigarettes can be an effective way to reduce your risk from the harmful effects of tobacco smoking while still satisfying a nicotine addiction,” Green says.